Embolic stroke of undetermined source: potential etiology and secondary prevention / 国际脑血管病杂志

The source of the emboli of embolic stroke of undetermined source (ESUS) is still unclear, and the effect of antithrombotic therapy is also different. The recurrence rate of stroke in patients with ESUS is higher, and antiplatelet therapy is still a commonly used secondary prevention scheme. This article reviews the potential causes, pathogenesis and secondary prevention of ESUS.

Efficacy of interventional therapy combined with butylphthalide and sodium chloride injection in treatment of patients with acute anterior circulation macrovascular occlusive stroke / 中华全科医师杂志

Objective:To assess the efficacy of butylphthalide and sodium chloride injection combined with interventional therapy in treatment of patients with acute anterior circulation macrovascular occlusive stroke.Methods:Clinical data of 92 patients with acute anterior circulation macrovascular occlusive stroke admitted to the Department of Neurology of Luoyang Central Hospital Affiliated to Zhengzhou University from February 2018 to June 2019 were retrospectively analyzed. Among them, 46 cases were treated with auxiliary arterial thrombolysis, aspiration thrombectomy or balloon dilatation (control group); and 46 patients were treated with butylphthalide and sodium chloride injection combined with Solitaire AB (S-AB) recyclable stent (study group). In control group the lesions were located in distal end internal carotid artery ( n=4), M1 segment of middle cerebral artery ( n=18) and M2 segment of middle cerebral artery ( n=24). In study group the lesions were located in the distal end of internal carotid artery ( n=5), M1 segment of middle cerebral artery ( n=15) and M2 segment of middle cerebral artery ( n=26). The cerebral infarction thrombolysis classification was used to evaluate vascular recanalization during operation. The neurological function of the patients before and 4 weeks after operation was evaluated with National Institutes of Health Stroke Scale Score (NIHSS); and the Disease Disability Scale Score (MRS) was also used to evaluate the neurological function before and 2 and 4 weeks after operation. Results:There was no significant difference in NIHSS score before treatment between control group and study group (22.8±5.2 vs. 23.4±4.1, t=0.614, P=0.54); after treatment the NIHSS of study group was significantly lower than that of control group (7.6±1.1 vs. 12.2±1.6, t=16.068, P<0.01). The success rate of vascular recanalization in the study group was higher than that of the control group [91%(42/46) vs. 76%(35/46), χ 2=3.903, P=0.04]. The short-term recanalization rate was 84% (39/46) and occlusion rate was 15%(7/46) in study group, while those in control group were 70% (32/46) and 30% (14/46), respectively (χ 2=6.566, P=0.01; χ 2=6.566, P=0.01) . MRS scores at 2 and 4 weeks after operation in the study group (5.51±0.34, 2.39±0.47) were better than those in the control group (6.87±0.46, 3.26±0.39; t=16.125, 9.661, all P<0.01) . Conclusion:Butylphthalide and sodium chloride injection combined with S-AB recyclable stent can enhance the nerve function and improve the hemagglutination mechanism in patients with acute anterior circulation macrovascular occlusive stroke and also significantly improve the vascular recanalization rate.

Paradoxical cerebral embolism caused by pulmonary arteriovenous fistula: a case report / 中华神经科杂志

A young female patient with paradoxical cerebral embolism caused by pulmonary arteriovenous fistula,mainly presented the right limbs asthenia,and brain magnetic resonance imaging examination showed multiple acute cerebral infarctions in the left hemisphere,which belongs to left middle cerebral artery and left posterior cerebral artery blood areas.After excluding the common risk factors of cerebrovascular disease,foaming test suggested the right-to-left shunt.The esophageal ultrasound examination excluded the patent foramen ovala.The lung CT angiography examination confirmed the intracranial embolism caused by pulmonary arteriovenous fistula.There was no recurrence of ischemic stroke after the patient was treated with pulmonary arteriovenous fistula embolization.

Study on mosaicism of SCN1A gene mutation in parents of children with Dravet syndrome / 中华儿科杂志

Objective@#To investigate the clinical phenotypes and the mutant allele proportion of parents with SCN1A gene mutation mosaicism of Dravet syndrome (DS) children, thus to provide guidance for family reproduction and prenatal diagnosis.@*Method@#The clinical data and peripheral blood DNA samples of DS patients with a SCN1A gene mutation proved by Sanger sequencing were collected prospectively from February 2005 to November 2016 in Department of Pediatrics, Peking University First Hospital. The same mutation was searched in parents and other available relatives. Parental somatic mosaicism was confirmed and quantified by Ion Torrent Personal Genome Machine (PGM) and Raindrop droplet digital PCR (ddPCR). The families were followed up and prenatal diagnosis was provided.@*Result@#Mosaicisms of SCN1A gene mutation in parents were identified in 5.2% (30 out of 575) DS families. Seventeen were fathers and thirteen were mothers. The mutant allele proportion ranged from 1.7% to 32.9% by PGM and from 0.82% to 34.51% by ddPCR, respectively. In 30 parents with somatic mosaicism, thirteen were asymptomatic, ten had a history of febrile seizures (FS), five with epilepsy, one with febrile seizure plus and one had a history of afebrile seizure. Four families had two children with DS. Three siblings of the probands were confirmed genetically with the same pathogenic mutation. One deceased sister of the proband was assumed to have the same pathogenic mutation because she matched DS diagnosis after medical history review despite no blood sample. Two families received prenatal diagnosis. One second pregnancy was terminated because the fetus inherited the mutation as the mother's wish.@*Conclusion@#Sanger sequencing detects parents of some children with DS are SCN1A mutation mosaics. PGM and ddPCR can be used for accurate quantification of mutant mosaics, which can provide accurate guidance for family genetic counseling.

Clinical study of aged patients with secondary benign paroxysmal positional vertigo / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the clinical features and evaluate the efficacy of manual reduction in treatment of age patients with secondary benign paroxysmal positional vertigo (s-BPPV).@*Methods@#Thirty-two cases of aged patients ( the s-BPPV group: including 19 cases of female and 13 males, age from 60 to 86 years old)with secondary benign paroxysmal positional vertigo from Jul. 2013 to Sep. 2015 in our hospital were retrospectively analyzed. The results were compared with 121 patients( the primary group: including 82 cases of female and 39males, aged from 60 to 86 years old)with aged primary benign paroxysmal positional vertigo(p -BPPV). All the patients were followed up for 12 months. Statistical data analysis was carried out with SPSS 19.0.@*Results@#20.92%(32/153)of all the observed elderly patients with BPPV was the aged s-BPPV. The sex ratio and onset age had no significant difference between the two groups(χ2=0.79, P>0.05; t=0.37, P>0.05). The rate of two or more semicircular canal involvement in the secondary group(21.88%) was higher than that in primary group(6.61%)(χ2=6.67, P<0.05). Bilateral semicircular canals were involved in 5 of the 32 cases in secondary group(15.63%) and 4 of the 121 cases in aged primary group(3.31%), The difference was significant(χ2=6.94, P<0.05). The effective rate after first manual reduction was 57.50%(23/40)in secondary group and 82.31%(107/130)in primary group, the difference was significant(χ2=10.46, P<0.05). The total effective rate were 87.50%(35/40) after more than once manual reduction in secondary group and 91.54%(119/130) in primary group, the difference was not significant(χ2= 0.59, P>0.05). The numbers of circulation of the first successful manual reduction management were (3.9±1.3)times in secondary group and (2.1±1.1)times in primary group, the difference was significant(t=3.15, P<0.05). The recurrence rate was 37.50%(15/40) in the secondary group and 16.15%(21/130)in primary group after during follow-up for 12 months, the difference was statistically significant(χ2=8.35, P<0.05).@*Conclusions@#It′s shown that the aged patients with secondary BPPV is not rare in clinical practice, sudden deafness and head trauma are frequent more than other reasons. The aged patients with secondary BPPV are prone to injury in multi-semicircular and bilateral canal compared with the primary BPPV. The effective rate after first manual reduction of secondary BPPV is lower than primary BPPV, it′s needed more circulation of first success in manual reduction management. The total effective rates are not significant in two groups and recurrence rate is relatively high in secondary group.

Dynamic changes of complement level in patients with acute coronary syndrome and its relationships with myocardial injury / 中华危重病急救医学

Objective To study relationships between myocardial injury and the levels of serum complement C3, C4 and C5b-9 in patients with acute coronary syndrome (ACS). Methods A retrospectively analysis was conducted. 170 ACS patients [including 110 cases of ST-segment elevation myocardial infarction (STEMI) and 60 cases of non-ST-segment elevation acute coronary syndrome (NSTE-ACS)] with ischemic chest pain or chest discomfort onset within the prior 12 hours admitted to the cardiology department of Tianjin Union Medicine Center from January 2014 to July 2016 were enrolled. Thirty-six healthy cases were enrolled as control during the same time. The levels of serum complement C3, C4 and C5b-9 on 1, 3 and 7 days after admission and myocardial function indicators were analyzed. Major adverse cardiovascular events (MACE) and readmission rate were analyzed after 1 year follow-up. The correlation between serum complement levels and myocardial function indicators was analyzed by Pearson correlation analysis. Results ① The levels of serum C3, C4 and C5b-9 on the first day in NSTE-ACS group and STEMI group were significantly higher than control group [C3 (g/L): 1.04±0.33, 1.26±0.35 vs. 0.39±0.21, C4 (g/L): 0.31±0.14, 0.33±0.10 vs. 0.19±0.07, C5b-9 (g/L): 575.46±197.26, 659.26±160.77 vs. 501.40±141.51, all P 140 scores, 83 cases). TnT and sICAM-1 in intermediate risk group were significantly increased as compared with low risk group. Levels of TnT, sICAM-1, C3, C4 and C5b-9 in the highest group were significantly higher than the low and intermediate risk groups, however the lowest LVEF was found in the highest group. ④ It was shown by Pearson correlation analyses that levels of serum C3, C4, C5b-9 were positively correlated with TnT (r value was 0.481, 0.367, 0.292, respectively, all P <0.01), sICAM-1 (r value was 0.298, 0.249, 0.365, respectively, all P < 0.01), but negatively correlated with LVEF (r value was -0.384, -0.260, -0.200, respectively, all P < 0.01). In addition sICAM-1 positively correlated with TnT (r = 0.536, P = 0.000), but negatively correlated with LVEF (r = -0.341, P = 0.001). Conclusions Serum complements activation was found in the acute phase of ACS patients. Serum complement C3, C4 and C5b-9 are involved in the process of myocardial injury, and may reflect severity of myocardial injury and cardiac dysfunction.

Targeting effect of TLS9a nucleic acid aptamer on mice hepatic cancer cells / 重庆医学

Objective To investigate the targeting effect of TLS9a nucleic acid aptamer on mice hepatic cancer cells.Methods The liposome modified with maleimide and loading doxorubicin(DOX) was prepared,then TLS9a nucleic acid aptamer modified by FITC fluorescence and sulfydryl was synthesized,which was coupled to the liposome surface.The entrapment efficiency of DOX was detected by UV spectrophotometry.The dynamic light scattering(DLS) was applied to measure the particle size of nanoparticles and the potential distribution.The uptake of DOX in mice hepatic cancer cells was detected by the Nikon inverted microscope and the mean fluorescence intensity of liposome/DOX and TLS9a-liposome/DOX was detected by flow cytometry.The cells activity was detected by MTT.Results Flow cytometry assay showed that the binding rate of TLS9a nucleic acid aptamer with BNL.1ME.A.7R.1 mice hepatic cancer cells was 54.1％.TLS9a-liposome particle size distribution was in (116.0 ± 5.0)nm.TLS9a-liposome/DOX released DOX quickly at pH 5.0,and the release amount in 72 h was more than 70 ％ of the total release amount.TLS9a-liposome/DOX effectively inhibited the growth of mice hepatic cancer cells BNL.1ME.A.7R.1.Conclusion TLS9a nucleic acid aptamer could specifically combined with mice hepatic cancer cells BNL.1ME.A.7R.1,which could be used to detect mice hepatic cancer cells.

Targeting effect of TLS9a nucleic acid aptamer on mice hepatic cancer cells / 重庆医学

Objective To investigate the targeting effect of TLS9a nucleic acid aptamer on mice hepatic cancer cells.Methods The liposome modified with maleimide and loading doxorubicin(DOX) was prepared,then TLS9a nucleic acid aptamer modified by FITC fluorescence and sulfydryl was synthesized,which was coupled to the liposome surface.The entrapment efficiency of DOX was detected by UV spectrophotometry.The dynamic light scattering(DLS) was applied to measure the particle size of nanoparticles and the potential distribution.The uptake of DOX in mice hepatic cancer cells was detected by the Nikon inverted microscope and the mean fluorescence intensity of liposome/DOX and TLS9a-liposome/DOX was detected by flow cytometry.The cells activity was detected by MTT.Results Flow cytometry assay showed that the binding rate of TLS9a nucleic acid aptamer with BNL.1ME.A.7R.1 mice hepatic cancer cells was 54.1％.TLS9a-liposome particle size distribution was in (116.0 ± 5.0)nm.TLS9a-liposome/DOX released DOX quickly at pH 5.0,and the release amount in 72 h was more than 70 ％ of the total release amount.TLS9a-liposome/DOX effectively inhibited the growth of mice hepatic cancer cells BNL.1ME.A.7R.1.Conclusion TLS9a nucleic acid aptamer could specifically combined with mice hepatic cancer cells BNL.1ME.A.7R.1,which could be used to detect mice hepatic cancer cells.

Value of high sensitive c-reactive protein and CD4/CD8 ratio for monitoring of lung infection in elderly patients with esophageal cancer / 国际检验医学杂志

Objective To explore the value f high sensitive c-reactive protein (hs-CRP) and CD4/CD8 ratio for monitoring of lung infection in elderly patients with esophageal cancer through detecting hs-CRP ,white blood cell (WBC)parameters and CD4 /CD8 ratio .Methods A total of 89 lung infection elderly patients with esophageal cancer after surgery from August 2012 to Decem-ber 2014 were collected as observation group ,special protein instrument ,blood cell analyzer and flow cytometry instrument were used to detect the hs-CRP ,WBC parameters ,CD4/CD8 ratio ,and compared with 82 cases of retired veteran cadres physical exami-nation for the same period in the control group .Results The hs-CRP ,WBC parameters ,CD4/CD8 in the preoperative group and the control group had no significant difference (P> 0 .05) .The three indicators in the preoperative group ,infection group and 3 days group had significant differences (P < 0 .05) ,although CD4/CD8 ratio in the cure group improved ,had not been completely im-proved .Conclusion Hs-CRP in diagnosis and monitoring of therapeutic efficacy is better than WBC parameters ,in the treatment of lung infection in elderly patients with esophageal cancer ,besides use the anti-infection treatment ,promote immune function recovery should not be ignored .

The clinical efficacy and influence of atorvastatin and urinary kallidinogenase on endothelin and inflammato-ry mediators in the treatment of elderly patients with acute cerebral infarction / 中国基层医药

Objective To observe the clinical efficacy and influence of atorvastatin and Urinary Kallidinoge-nase on rheology,endothelin and inflammatory mediators in the treatment of elderly patients with acute cerebral infarc-tion,and to guide clinical treatment.Methods 86 patients with acute cerebral infarction were randomly divided into 43 cases of the observation group and 43 cases of the control group.Both groups were given conventional therapy,then the control group were given atorvastatin(20mg/d,qd),the observation group were given atorvastatin(20mg/d,qd) and Urinary Kallidinogenase(0.15PNA /time).2 weeks were set for a course of treatment,NIHSS score and ADL score were calculated before and after treatment.Then endothelin,CRP,IL -1 and hemorheology were measured by phlebotomized when limosis to evaluated the efficacy.Results The high shear whole blood viscosity,erythrocyte ag-gregation index,hematocrit,fibrinogen,erythrocyte sedimentation rate,endothelin,CRP,IL -1 and NHISS of the ob-servation group and control group after treatment were respectively (3.45 ±0.21)mpa/s vs.(4.89 ±0.31)mpa/s, (4.05 ±0.56)vs.(6.43 ±0.63),(33.4 ±3.4)% vs.(39.8 ±3.7)%,(2.43 ±0.72)g/mL vs.(3.18 ±0.64)g/mL,(20.5 ±7.5)mm/h vs.(27.3 ±7.3)mm/h,(58.8 ±5.7)pg/L vs.(70.7 ±7.5)pg/L,(6.68 ±2.96)mg/L vs.(16.78 ±8.97)mg/L,(3.64 ±1.56)ng/L vs.(6.53 ±2.64)ng/L,(8.2 ±3.3)point vs.(15.5 ±6.3)point. Data of both groups were significantly lower than before treatment,(t =5.234 vs.4.267,4.627 vs.3.532,4.872vs.3.726,5.021 vs.3.429,6.046 vs.3.848,10.477 vs.6.818,11.557 vs.6.686,9.267 vs.6.421,12.712 vs. 5.044,all P <0.05).The ADL score were (28.7 ±11.2)point vs.(22.5 ±10.1)point,and the data of both groups were significantly higher than before treatment (t =8.396 vs.5.336,all P <0.05).The high shear whole blood vis-cosity,erythrocyte aggregation index,hematocrit,fibrinogen,erythrocyte sedimentation rate,endothelin,CRP,IL -1 and NHISS of the observation group were significantly lower than the control group(t =3.207,3.388,3.667,3.761, 3.959,3.929,3.884,3.304,3.778,all P <0.05).The ADL score of the observation group were significantly higher than the control group(t =3,447,P <0.05);The total effective rate of the observation group and control group were 95.35% (41 /43 )vs 69.77% (30 /43 ),the difference was statistically significant (χ2 =10.904,P <0.05 ). Conclusion The method contained atorvastatin and urinary kallidinogenase have exact clinical efficacy,can improve neurological deficit assessment and the ability of daily life.Its mechanism may be that it can reduce endothelin levels of inflammatory mediators and improve blood circulation,which is worthy of clinical use.

Clinical features and antimicrobial susceptibility of pulmonary infection with staphylococcus aureus / 实用医学杂志

Objective To analyze the clinical data of Staphylococcus aureus sputum culture positive cases and the antimicrobial susceptibility of Staphylococcus aureus strains isolated from them and provide the evidence for clinical diagnosis and treatment. Methods Retrospectively analyze the clinical data of Staphylococcus aureus sputum culture positive cases of our hospital from January 2014 to December 2014. Results The Staphylococcus aureus sputum culture positive cases was 111 in all, while antimicrobial sensitive test was performed in 110 cases, including MSSA in 27 cases (24.55%), MSRA in 83 cases (74.45%), community infection MSRA in 13 cases (15.66%), hospital infection MRSA in 70 cases (84.34%). The cases were mainly from the department of respiratory diseases, department of neurosurgery, ICU, the department of neurology, accounting for 75.68%. The risk rate of community acquired MRSA in patients from nursing center were significantly higher than that of hospital infection MRSA and MSSA (P = 0.004). The antimicrobial susceptibility rate of community infection MRSA to clindamycin, gentamicin, erythromycin, azithromycin was higher than that of hospital infection MRSA. Conclusion The susceptibility rate in non-β-lactams of community infeciton MRSA was higher than that of hospital infection MRSA.

Diagnostic value of N-terminal-pro-brain natriuretic peptide for patients with acute exacerbation of chronic obstructive pulmonary disease complicated with left heart failure / 实用医学杂志

Objective To discuss the diagnostic value of N-terminal-pro-brain natriuretic peptide (NT-proBNP) for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with left heart failure. Methods Patients with medical history of AECOPD, or are diagnosed as AECOPD from March 2014 to February 2015 were involved in the study. Based on echocardiography and clinic characteristics , the patients were divided into left heart failure group (group A) and non-left heart failure group (group B). Related factors of elevated NT-proBNP in AECOPD and the diagnostic value of NT-proBNP for patients with AECOPD complicated with left heart failure were analyzed , and exclusive and diagnostic cutoff were worked out. Results In this study , 109 AECOPD patients were collected , including 21 patients in group A and 88 patients in group B. Multivariate linear regression analysis indicated NT-proBNP was positively associated with PCT (β=0.180,P = 0.011) and PAP(β = 0.333,P = 0.000), and negatively with LVEF(β = -0.511,P = 0.000)and the area under the ROC curve(AUC) was 0.959 (95% confidence interval:0.915-1.002,P = 0.000). The exclusive cutoff was 794.6 pg/mL(sensitivity:90.5%,specificity:92%), and the diagnostic cutoff 1 618 pg/mL(sensitivity:85.7%,specificity: 97.7%). Conclusions NT-proBNP can help to diagnose whether AECPOD patients are complicated with left heart failure. Besides left heart dysfunction and the state of systemic inflammation , pulmonary hypertension may be the reasons for the elevated NT-proBNP in AECOPD patients.

ATP1A3 gene mutations in patients with alternating hemiplegia of childhood / 中华儿科杂志

<p><b>OBJECTIVE</b>To analyze the ATP1A3 mutations in patients with alternating hemiplegia of childhood (AHC) and recognize its value in diagnosing atypical cases.</p><p><b>METHOD</b>Data of all AHC patients seen at Peking University First Hospital from August 2005 to November 2014 were prospectively collected. Clinical information of the AHC patients and their family members were collected and analyzed. Genomic DNAs were extracted from their peripheral blood. Mutations in ATP1A3 were screened by Sanger sequencing after PCR.</p><p><b>RESULT</b>A total of 78 AHC patients were recruited, including 50 males and 28 females. Only three patients had family history of AHC. The first family case had affected mother with AHC; the second family case was the older one of a monozygotic male twins with AHC but their parents were normal; the third family case had a sister with AHC but their parents were normal. The age of onset ranged from six hours to eight years and six months (median: 4 months). According to the Aicardi's clinical diagnostic criteria, 72 patients were considered as typical AHC cases and the other six patients were considered as atypical AHC cases for their age of onset was older than 18 months. Twenty-seven different missense ATP1A3 mutations were detected in 71 (91.0%, 71/78) patients with AHC, including 66 typical and 5 atypical cases. 11 novel ATP1A3 mutations were first reported. ATP1A3 mutations were identified in the three AHC cases with family history. Parental analysis verified that the ATP1A3 mutation of 63 patients (95.5%, 63/66) were de novo origin except lack of five unavailable maternal or paternal genomic DNA. Mutation D801N was found in 20 cases (28.2%), and E815K in 12 cases (16.9%). In the six atypical AHC patients, ATP1A3 mutations were detected in five of them.</p><p><b>CONCLUSION</b>ATP1A3 was the major causative gene of AHC, and mutations were identified as de novo mostly. ATP1A3 mutations in AHC had mutational hotspot, and the most common mutations were D801N and E815K. ATP1A3 mutation screening is helpful for the genetic and definite diagnosis of the atypical AHC cases.</p>

Effect of atorvastatin combined with Xuesaitong injection in the treatment of elderly patients with acute cere-bral infarction / 中国基层医药

Objective To observe the effect and the influence on carotid atherosclerotic plaques,C-reactive protein,lipids,coagulation of atorvastatin and xuesaitong injection in the treatment of elderly patients with acute cere-bral infarction.Methods 100 elderly patients with acute cerebral infarction met inclusion criteria were randomly divided into 50 cases of the observation group and 50 cases of the control group,the control group were given conven-tional therapy,the observation group were given atorvastatin and xuesaitong injection on the basis of the control group, atorvastatin calcium 20mg/d,qd,Xuesetong 400mg/times,qd,both groups had been treated for 3 weeks for a course of treatment,the serum C-reactive protein,serum lipids and coagulation parameters were detected before and after treat-ment,the IMT and carotid plaque area were determined by color Doppler ultrasonography,NIHSS score were calculat-ed.Results The PT,APTT,CRP,IMT,carotid plaque area,NIHSS score of the observation group were (18.07 ± 2.24)s,(36.59 ±3.52)s,(11.2 ±3.6)mg/L,(0.57 ±0.16)mm,(1.36 ±0.32)cm2,(9.31 ±2.06)point,the observation group were (15.24 ±1.88) s,(31.84 ±2.55) s,(26.4 ±6.7) mg/L,(0.68 ±0.13) mm,(1.55 ± 0.37)cm2,(15.86 ±2.25)point,both groups were significantly improved after treatment than before treatment (all P<0.05),The total efficiency of observation group and control group were 96%and 72%,the observation group was significantly higher than those of the control group, the difference was statistically significant (χ2 =10.867, P <0.01).Conclusion The method containing atorvastatin and Xuesaitong injection can effectively regulate blood lipid levels and blood coagulation,inhibit vascular inflammation,Stabilizing or reversing carotid artery plaque,reduce carot-id intima-media thickness,can inhibit thrombosis and progress,improve cerebral hypoxia and ischemia parts neurologi-cal defects,improve clinical outcomes,significantly improved clinical outcomes.

Safety of modified sputum induction in moderate-to-very severe COPD during exacerbation / 实用医学杂志

Objective To evaluate the safety of modified sputum induction in moderate to very severe COPD during exacerbation. Methods Ninety patients with moderate, severe or very severe COPD during exacerbation (27 with type Ⅰ and Ⅱ respiratory failure,18 with coronary heart disease, 38 with tachycardia) were chosen as research subjects. All the patients underwent induced sputum. During induction , all patients were given electrocardiographic monitoring and pulmonary function check every 5 minutes and FEV1, HR, SpO2 in the process of testing were recorded. Results Ninety patients underwent 224 sputum inductions progress, 222 were safety. Qualified sputum samples were collected for 216 times, sputum induction was successful in 96.43% of occasions. Heart rate rising and SpO2 reducing during sputum induction mainly occurred in the beginning 5 minutes, FEV1 did not change in the whole process. Conclusion Modified sputum induction can be safe through closely monitoring in patients with moderate-to-very severe COPD with exacerbation, even with type Ⅰ or typeⅡ respiratory failure. But the risk of sputum induction will increase if patients with coronary heart disease and tachyarrhythmia, especially within beginning 5 minutes of sputum induction.

A cross-sectional survey and analysis of hospital infection in Pukou Hospital in 2012 / 重庆医学

Objective To investigate and analyze the prevalence rate as well as antibiotics use in this hospital and to improve the awareness of the hospital infection administration for the medical staff .Methods The hospital infection prevalence rate in hospital and the risk factors were analyzed by prevalence survey and bed-side and case records investigation .Results In all 320 patients sur-veyed ,25 patients were diagnosed with hospital infection and the rate was 7 .81% ;27 cases of hospital infection was reported and the cases prevalence rate was 8 .44% .The main infection site was respiratory tract and it accounted for 48 .14% ,moreover ,the in-tensive care unit ,urology ,and neurology were the high incidence departments .The day of usage rate of antimicrobial drug was 62 .50% ,prevention of drug use was 46 .50% ,a kind drug use was 74 .00% ,and the two kind drug uses was 22 .00% .The positive rate of hospital infection pathogenic detection was 46 .87% .Hospital infection rate was related to the age ,urinary tract intubation , and ventilator factors .Conclusion Hospital infection administration should be strengthened to reduce invasive procedures for key depart-ments and focus groups ,meanwhile ,the rational application of antibiotics should be regulated to reduce hospital infection rates .

Distribution and drug resistance profiles of pathogenic bacteria isolated from patients with nosocomial infection in intensive care unit / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the distribution and drug sensitivity of pathogenic bacteria isolated from patients with nosocomial infection in intensive care unit.</p><p><b>METHODS</b>The clinical data were collected from 229 hospitalized patients with nosocomial infection in intensive care unit from 2009 to 2011.</p><p><b>RESULTS</b>Gram-negative bacteria were the main pathogens (68.25%) in the intensive care unit. From 2009 to 2011, the annual isolation rate of multidrug-resistant baumannii showed a significant reduction with time (39.13%, 18.18%, and 15%, respectively, P<0.05), while the prevalence of multidrug-resistant Pseudomonas aeruginosa, ESBLs-producing Escherichia coli and Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus, coagulase-negative staphylococci methicillin-resistant strains showed no significant changes in the 3 years (P>0.05). The overall sensitivity of gram-negative bacilli to the antimicrobial agents tended to increase with time. The Gram-negative bacilli remained highly sensitive to carbapenems, tigecycline, amikacin and piperacillin/tazobactam; the Gram-positive bacilli were highly sensitive to vancomycin, quinoline Nupu Ting/dalfopristin, linezolid, and tigecycline with sensitivity rates all reaching 100%.</p><p><b>CONCLUSION</b>Adherence to the principles of antibiotic use and effective monitoring and preventive measures are encouraged to reduce antibiotic resistance rates of the bacteria and the incidences of hospital infection.</p>

Preservation of laryngeal function in treatment of pyriform sinus carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the treatment outcome of laryngeal function sparing of pharyngectomy in pyriform sinus carcinoma.@*METHOD@#Fourty-two cases with pyriform sinus cancer in laryngeal function sparing surgery were collected from 1989 to 1999. The method of operation, the complication and surviving rate were analyzed.@*RESULT@#The decannulation rate was 61.9% (26/42) . The rate of complication was 31.0% (13/42), the 3 years and 5 years' survival rates were 76.1% and 66.6% respectively.@*CONCLUSION@#Laryngeal function preserving surgery in pyriform sinus cancer could performed for stage T1, T2 and part of stage II, IV patients, and this surgery can improve the patients, life quality.

Regulation effect of polyethylene glycol relative molecular weight and dosage on porous structure and property of calcium alginate scaffold / 中国组织工程研究

AIM: Based on the water-solubility of polyethylene glycol (PEG) with different relative molecular weight (RMW) and sodium alginate, we investigated the porous structure and property of calcium alginate scaffold with different RMW and dosages of PEG, which was used as porogenic agent. METHODS: The experiment was carried out in the Key Laboratory of Biomedical Engineering and Biomaterials, Jinan University from March 2006 to September 2007.①PEG at different RMWs (Mw=2 000, 4 000, 6 000, 8 000, 10 000, 20 000, 35 000) and different dosages (mass fraction=0, 0.01, 0.02, 0.03, 0.04, 0.05, 0.06) were added into sodium alginate solution at 0.02 mass fraction. Then alginate was crosslinked, solidified and molded into indiscerptible film and graininess through Ca2+. PEG was dissolved by water. Therefore, a mass of porous structures could be formed in alginate.②Water content and swelling ratio of alginate was tested. Scanning electron microscope was used to observe the porous configuration. RESULTS: ①Porous alginate scaffold could be obtained through PEG and it exhibited good intensity and toughness, with water content reaching 92%. The scaffold could be formed into film and graininess.②Scanning electron microscope results revealed that the distribution of porous structure was uniformed. The aperture was 43.75 ?m-2.8 mm, and could be controlled by PEG's RMW and dosage. Inflated and uniform aperture structure was harvested when RMW of PEG was 4 000 and 6 000. CONCLUSION: Porous alginate structure can be obtained through regulating PEG's RMW and dosage. High water content and porosity of alginate scaffold material can be used in cell culture of tissue engineering and used as controlled release matrix of bio-active component.

Clinical research of donepezil hydrochloride in treatment of vascular dementia / 中国康复理论与实践

@#ObjectiveTo assess the clinical efficacy and safety of donepezil in treating the mild to moderate cognitive impairment of vascular dementia.Methods60 patients with vascular dementia were randomly divided into therapy group (donepezil 5 mg/d for 4 weeks, and then increased to 10 mg/d) and control group (piracetan 800 mg,3/d). All patients were assessed with Mini Mental State Examination (MMSE), Wechsler Adult Intelligence Revised in China (WAIS-RC), Activities of daily living (ADL), and Clinical Global Impression (CGI), before and 12 weeks after treatment. ResultsMMSE scores improved significantly in both groups after the treatment. The therapy group produced significantly better scores than the control groups on the MMSE(P<0.05). WAIS-RC scores improved significantly in the therapy groups(P<0.01), but there was no significant difference for control groups(P>0.05), before and after treatment. Severity Improvement(SI) score of ADL and CGI in the both groups decreased. The total efficiencies of donepezil and piracetan groups were 86% and 56% respectively. There was no significant difference in adverse effects between two groups. ConclusionDonepezil can improve the cognitive function of patients with vascular dementia, which seems better than that of piracetan, and it is fairly safe for vascular dementia patients to take donepezil 10 mg a day.